Addition of dexamethasone to prolong peripheral nerve blocks: a ChatGPT-created narrative review.

Chat Generative Pre-trained Transformer (ChatGPT), an artificial intelligence chatbot, produces detailed responses and human-like coherent answers, and has been used in the clinical and academic medicine. To evaluate its accuracy in regional anesthesia topics, we produced a ChatGPT review on the addition of dexamethasone to prolong peripheral nerve blocks. A group of experts in regional anesthesia and pain medicine were invited to help shape the topic to be studied, refine the questions entered in to the ChatGPT program, vet the manuscript for accuracy, and create a commentary on the article. Although ChatGPT produced an adequate summary of the topic for a general medical or lay audience, the review that were created appeared to be inadequate for a subspecialty audience as the expert authors. Major concerns raised by the authors included the poor search methodology, poor organization/lack of flow, inaccuracies/omissions of text or references, and lack of novelty. At this time, we do not believe ChatGPT is able to replace human experts and is extremely limited in providing original, creative solutions/ideas and interpreting data for a subspecialty medical review article.

The Impact of Spinal Needle Selection on Postdural Puncture Headache: A Meta-Analysis and Metaregression of Randomized Studies.

BACKGROUND AND OBJECTIVES: Potentially broadened indications for spinal anesthesia require increased understanding of the risk factors and prevention measures associated with postdural puncture headache (PDPH). This review is designed to examine the association between spinal needle characteristics and incidence of PDPH. METHODS: Meta-analysis and metaregression was performed on randomized controlled trials to determine the effect of needle design and gauge on the incidence of PDPH after controlling for patient confounders such as age, sex, and year of publication. RESULTS: Fifty-seven randomized controlled trials (n = 16416) were included in our analysis, of which 32 compared pencil-point design with cutting-needle design and 25 compared individual gauges of similar design. Pencil-point design was associated with a statistically significant reduction in incidence of PDPH (risk ratio, 0.41; 95% confidence interval, 0.31-0.54; P < 0.001; I = 29%) compared with cutting needles among studies that assessed both design types. Subgroup analysis among obstetric and nonobstetric procedures yielded similar results. After adjustment for significant covariates, metaregression analysis among all 57 included trials revealed a significant correlation between needle gauge and rate of PDPH among cutting needles (slope = -2.65, P < 0.001), but not pencil-point needles (slope = -0.01, P = 0.819). CONCLUSIONS: Pencil-point needles are associated with significantly lower incidence of PDPH compared with the cutting-needle design. Whereas a significant relationship was noted between needle gauge and PDPH for cutting-needle design, a similar association was not shown for pencil-point needles. Providers may consider selection of larger-caliber pencil-point needle to maximize technical proficiency without expensing increased rates of PDPH.

The Impact of Neuraxial Versus General Anesthesia on the Incidence of Postoperative Surgical Site Infections Following Knee or Hip Arthroplasty: A Meta-Analysis.

BACKGROUND: Recent studies have yielded conflicting results on the association between anesthesia technique and incidence of postoperative surgical site infections (SSIs) after knee arthroplasty (KA) and hip arthroplasty (HA). Our group conducted a meta-analysis of all available studies to clarify this potential association. METHODS: Our group searched MEDLINE, EMBASE, and Google Scholar for all relevant studies (1990-2015) reporting on the association between anesthetic technique and SSI after KA or HA. Meta-analysis was performed to estimate both the pooled unadjusted odds ratio (OR) and adjusted OR (aOR) using a random-effects model. Subgroup analyses and metaregression were conducted to explore potential sources of heterogeneity and bias. RESULTS: Of the initial 435 records, 13 studies (n = 362,029) met the inclusion criteria. The use of neuraxial anesthesia was associated with a significant reduction in incidence of postoperative SSI as compared with general anesthesia for all arthroplasties based on unadjusted (OR, 0.77; 95% confidence interval [CI], 0.70-0.86; P < 0.001) and adjusted (aOR = 0.84; 95% CI, 0.76-0.92; P < 0.001) data. Subgroup analyses showed similar reductions in incidence of postoperative SSI for KA (OR = 0.75; 95% CI, 0.68-0.84; P < 0.001; aOR = 0.85; 95% CI, 0.79-0.92; P < 0.001) and HA (OR = 0.79; 95% CI, 0.65 to 0.95; P = 0.02; aOR = 0.84; 95% CI, 0.71-1.00; P = 0.057). CONCLUSIONS: Synthesis of the existing evidence supports the overall beneficial effects of neuraxial anesthesia in decreasing the development of SSI after joint arthroplasty (KA and HA). Given the limitations associated with interpretation of data from large observational trials, further investigation using prospective randomized trial design is warranted in this promising area.

Curriculum development for an advanced regional anesthesia education program: one institution's experience from apprenticeship to comprehensive teaching.

Results of recent attitude survey studies suggest that most practicing physicians are inadequately treating postoperative pain. Residents in anesthesia are confident in performing lumbar epidural and spinal anesthesia, but many are not confident in performing the blocks with which they have the least exposure. Changes need to be made in the training processes to a comprehensive model that prepares residents to perform a wider array of blocks in postgraduate practice. Here, we describe one institution's approach to creating a standardized, advanced regional anesthesia curriculum for residents that follows the six core competencies of the ACGME. Residents received training in anatomy dissection, ultrasound-guided regional anesthesia, traditional nerve stimulation techniques, problem-based learning and simulation sessions, oral board presentation sessions, and journal club sessions. Residents kept a detailed log for their use of peripheral nerve block procedures. We have now redesigned and implemented an advanced regional anesthesia program within our institution to provide residents with experience in regional anesthesia at a competent level. Resident's knowledge in regional anesthesia did improve after the first year of implementation as reflected in improvements between the pre- and post-tests. As the advanced regional anesthesia education program continues to improve, we hope to demonstrate levels of validity, reliability, and usability by other programs.

Ethical questions regarding health insurance in India.

Improved health and healthcare are of vital concern to the welfare of Indian society. The nascent health insurance system of the country is experiencing an explosive expansion and various models of health insurance provision are under trial by different agencies. Since the country has been relatively late in introducing health insurance, it can study the effects of different systems of healthcare and insurance and develop a system of health coverage which addresses the unique social character of our country as well as the ethical questions of comprehensiveness and inclusion. This article seeks to explore these issues in detail.